lung auscultation

NEJM just came out with review article on lung auscultation ( see lung auscultation nejm 2014 in dropbox, or DOI: 10.1056/NEJMra1302901).  it does seem that we are moving towards using echocardiograms instead of cardiac auscultation, bolstered by studies confirming that cardiologists ain't so great at predicting whether a murmur is from the right or left side of the heart. and, seems that at the slightest hint of lung problems, CTs are the way to go. although i am being a tad sarcastic, my sense is that medical students/residents/perhaps some of the younger attendings are not as fluent as some of us more traditionally-trained ones (a euphemism for older ones....) so, will circulate this article. a few points:

--some of the nomenclature has evolved over the years. for better or worse, rales don't exist anymore. just crackles. and "moist" vs "dry" is out (turns out that one person's moist is another's dry, and neither seemed to correlate with much), though there are fine vs coarse crackles (fine being short, heard mid-to-late inspiration, nonclearing with cough, and associated more with interstitial fibrosis, CHF, pneumonia; coarse being early inspiratory and throughout expiration, clear with cough and often related to secretions). and now there are "squawks", with a short musical component/short wheeze, accompanied or preceded by crackles (signifying problem with distal airways, could be interstitial lung dz or pneumonia)
--their table is a good (xeroxable) one of the different sounds and where they come from/what they usually mean.
--and, just to show the value of auscultation, in a study of 386 workers exposed to asbestos, auscultation-detected crackles were 100% accurate in identifying asbestosis, i.e. as good as CT  (they were obviously looking for it/listening with a focus, but pretty impressive anyway)

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